Reimbursement Officer I
Found in: Talent US 2 C2 - 7 days ago
Reimbursement Officer I
Come work in an environment where we truly value and respect those we serve and believe in the mission that all people can achieve a higher level of wellness and independence.
The state supported living centers serve people with intellectual and developmental disabilities who are medically fragile or who have behavioral problems. The centers provide campus-based direct services and supports at 13 centers located throughout the state.
The state of Texas offers many benefits to employees. HHSC is a qualifying organization for the Federal Public Service Loan Forgiveness Program, which forgives the remaining balance on college student Direct Loans after making qualifying monthly payments. We also offer excellent health benefits, a lifetime monthly retirement annuityas well as (k) and Programs under the Employees Retirement System of Texas.
If you are looking for a place to work where you can establish a career that is filled with purpose, this is the job for you
The Reimbursement Officer performs routine reimbursement or claims processing work. Maintains files on each Medicare covered individual and gathers all rendered reimbursable services from the individual’s charts for purpose of billing. Maintains a working master list containing Medicare information on each individual covered by Medicare and participates in Medicare Audits. Performs various activities necessary to collect Medicare under the Intermediate Care Facilities for individuals with Intellectual Disability (ICF/ID) program. Completes and submits applications and forms in a timely manner to enroll each physician in the ICF/ID Medicare program. Responsible for enrolling each eligible individual into a Medicare Part D plan. Performs regular office functions including file maintenance, answering telephones, greeting visitors and computer entry daily.
Essential Job Functions:
Attends work on a regular basis and may be required to work a specific shift schedule or, at times, even a rotating schedule, extended shift and/or overtime in accordance with agency leave policy and performs other duties as assigned.
Gathers all rendered, reimbursable services for individuals with Medicare on a monthly basis. Meets with facility
physicians to ensure the codes used are the most accurate for rendered services
Prepares a Monthly Charge Report for individuals with Medicare, using information pulled from IRIS and Individuals'
medical charts. Reviews the information for accuracy and makes corrections as necessary using a current Medicare Fee Schedule.
Enrolls eligible individuals into a Medicare Part D Drug Program that best fits the individuals needs, and enters the
information in the online CARE System.
Establishes and maintains records on a daily basis, including documents, correspondence, forms, and lists for each individual with Medicare on campus, as well as maintains an Excel list with Medicare information updates as necessary.
Prepares Medicare enrollment or revalidation forms for physicians who are employed or contracted by the facility.
Assists in Medicare audits, and other related work, as required.
Other duties as assigned include but are not limited to actively participating and/or serving in a supporting role to meet the agency’s obligations for disaster response and/or recovery or Continuity of Operations (COOP) activation. Such participation may require an alternate shift pattern assignment and/or location.
Knowledge Skills Abilities:
Knowledge of the principles of collection and accounting, and of the rules and regulations governing
reimbursement for agency services.
Knowledge of the workings of Medicare Part A, Part B and Part D, as well as ICD-10-CM, CPT and HCPCS codes used when gathering monthly billing information
Skill in use of Electronic Health Records (IRIS), general office equipment, and in the operation of computers and applicable computer software.
Ability to communicate effectively
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